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Introduction: The most appropriate airway management technique for use by paramedics in out-of-hospital cardiac arrest is yet to be determined and evidence relating to the influence of airway management strategy on outcome remains equivocal. In cases where return of spontaneous circulation (ROSC) occurs following out-of-hospital cardiac arrest, patients may undergo direct transfer to a specialist heart attack centre (HAC) where the post resuscitation 12 lead ECG demonstrates evidence of ST elevation myocardial infarction. To date, no studies have investigated the role of airway management strategy on outcomes in this sub-set of patients. The AMICABLE (Airway Management In Cardiac Arrest, Basic, Laryngeal mask airway, Endotracheal intubation) study therefore sought to investigate the influence of prehospital airway management strategy on outcomes in patients transferred by the ambulance service directly to a HAC post ROSC. Methods: Adults with ROSC post out-of-hospital cardiac arrest who met local criteria for transfer to a HAC were identified prospectively. Ambulance records were reviewed to determine prehospital airway management approach and collect physiological and demographic data. HAC notes were obtained to determine in-hospital course and quantify neurological outcome via the Cerebral Performance Category (CPC) scale. Neurologically intact survivors were contacted post discharge to assess quality of life via the SF-36 health survey. Statistical analyses were performed via Chi-square, Mann Whitney U test, odds ratios, and binomial logistic regression. Results: A total of 220 patients were recruited between August 2013 and August 2014, with complete outcome data available for 209. The age of patients ranged from 22-96 years and 71.3% were male (n=149). Airway management was undertaken using a supraglottic airway (SGA) in 72.7% of cases (n=152) with the remainder undergoing endotracheal intubation (ETI). There was no significant difference in the proportion of patients with good neurological outcome (CPC 1&2) between the SGA and ETI groups (p=.286). Similarly, binomial logistic regression incorporating factors known to influence outcome demonstrated no significant difference between the SGA and ETI groups (Adjusted OR 0.725, 95% CI 0.337-1.561). Clinical and demographic variables associated with good neurological outcome included the presence of a shockable rhythm (p < .001), exposure to angiography (p < .001), younger age (p < .001) and shorter time to ROSC (p < .001). Due to an inadequate response rate (25.4%, n=15) analysis of SF36 data was limited to descriptive statistics. Limitations: The study only included patients who achieved ROSC and met the criteria for direct transfer to a HAC. Results are therefore not generalisable to more heterogenous resuscitation populations. Accuracy of clinical decision making and ECG interpretation were not assessed and therefore some patients included in the study may have been inappropriately transferred to a HAC. The low SF-36 survey response rate limited the level of neurological outcome analysis that could be undertaken. Conclusion: In this study, there was no significant difference in the proportion of good neurological outcomes in patients managed with SGA versus ETI during cardiac arrest. Further research incorporating randomised controlled trials is required to provide more definitive evidence in relation to the optimal airway management strategy in out-of-hospital cardiac arrest.

L’insuffisance cardiaque aigue est une émergence médicale qui nécessite une prise en charge multidisciplinaire. L’Extracorporeal Life Support (ECLS) peut être envisagé comme option thérapeutique pour les formes d’insuffisance cardiaque aigue réfractaire au traitement conventionnel. L’objectif de ce projet de recherche clinique est de fournir une vue d’ensemble de l’ECLS dans la prise en charge du choc cardiogénique et de l’arrêt cardiaque réfractaire. L’intoxication médicamenteuse et la myocardite sont les meilleures indications à l’implantation de l’ECLS en considération de leur potentiel de récupération myocardique très élevé. La défaillance primaire du greffon après transplantation cardiaque et l’infarctus du myocarde présentent des résultats plus mitigés avec l’ECLS en raison d’une physiopathologie plus complexe. Le choc cardiogénique postcardiotomie après une intervention de chirurgie cardiaque montre des résultats décevants en raison du profile préopératoire des patients. L’arrêt cardiaque aussi exige une prise en charge immédiate et l’ECLS peut être considéré comme une solution thérapeutique de sauvetage. Une meilleure sélection des patients s’impose afin d’améliorer les résultats de l’ECLS pour l’arrêt cardiaque réfractaire intrahospitalier. Les résultats de l’ECLS pour l’arrêt cardiaque réfractaire extrahospitalier sont dictés principalement par le temps de réanimation cardio-pulmonaire et le rythme cardiaque. Les rythmes non choquables pourraient être considérés comme une contre-indication formelle à l’utilisation de l’ECLS autorisant une concentration de nos efforts sur les rythmes choquables où les chances de survie sont plus importantes / Acute heart failure is a clinical situation requiring a prompt multidisciplinary approach. Extracorporeal Life Support (ECLS) could represent a therapeutic option for acute heart failure refractory to standard maximal treatment. The aim of this report is to offer an overview of ECLS in the management of refractory cardiogenic shock and cardiac arrest. Drug intoxication and myocarditis are the best indications of ECLS in consideration of their high potential of myocardial recovery. Primary graft dysfunction after heart transplantation and acute myocardial infarction show reduced survival rates owing to their more complex pathophysiology. Postcardiotomy cardiogenic shock after cardiac surgery operations displays poor outcomes due to the preoperative profile of the patients. ECLS could be also considered as a rescue solution for refractory cardiac arrest. A better selection of in-hospital cardiac arrest patients is mandatory to improve ECLS outcomes. In-hospital cardiac arrest patients with a reversible cause like drug intoxication and acute coronary syndrome should benefit from ECLS whereas end-stage cardiomyopathy and postcardiotomy patients with an unclear cause of cardiac arrest should be contraindicated to avoid futile support. ECLS for refractory out-ofhospital cardiac arrest should be limited in consideration of its poor, especially neurological, outcome and the results are mainly limited by the low-flow duration and cardiac rhythm. Nonshockable rhythms could be considered as a formal contraindication to ECLS for refractory out-of-hospital cardiac arrest allowing a concentration of our efforts on the shockable rhythms, where the chances of success are substantial

Bakgrund Sjukvårdspersonal får dagligen handskas med etiska överväganden och beslut. Ställningstagandet om när livsuppehållande behandling ska fortsätta eller avslutas är ett komplext beslut som kräver flera överväganden. Läkaren har det fulla ansvaret vid ställningstagandet om att avsluta livsuppehållande behandling. Sjuksköterskan besitter ofta viktig kunskap och kännedom om patientens behov, vilket kan bidra till beslutsprocessen med betydelsefull information. Syfte Syftet med litteraturstudien var att belysa sjuksköterskans upplevelse av delaktighet och kommunikation gällande det etiska ställningstagandet om att avsluta eller avstå från patientens livsuppehållande behandling. Metod Beskrivande litteraturöversikt av tio kvalitativa vetenskapliga artiklar. Resultat Analysen resulterade i två teman; delaktighet och kunskapsbrist. Resultatet visade att sjuksköterskor ansåg sitt deltagande i ställningstagandet om att bibehålla eller avsluta livsuppehållande behandling som bristande. Sjuksköterskan upplevde att samarbetet med läkaren i beslutsprocessen inte fungerade och kände ofta en frustration över att inte bli tillräckligt lyssnad på. Ytterligare hinder för sjuksköterskans delaktighet i beslutsprocessen framkom av sjuksköterskors kunskapsbrist gällande lagar, riktlinjer och etik samt bristande arbetserfarenhet och självförtroende.  Slutsats Sjuksköterskans delaktighet i vårdteamet kring ställningstagandet om att bibehålla eller avsluta livsuppehållande behandling är bristfälligt. Ytterligare belyser studien sjuksköterskans behov av ökad kunskap inom lagar, riktlinjer och etik. / Background Healthcare professionals deal with ethical considerations and standpoints on a daily basis. Decision-making about when life-sustaining treatment should be continued or terminated is a complex position that requires several considerations. The doctor has the full responsibility regarding the standpoint to discontinue life sustaining treatment. The nurse often possesses important knowledge and understandings of the patient´s needs, which can provide important information in the decision making. Aim The aim of the study was to illustrate nurse´s experience of participation and communication regarding the ethical decision-making to terminate or refrain from patients life-sustaining treatment. Method Descriptive litterature review of ten qualitative research articles. Results The study resulted in two themes; participation and lack of knowledge. The results show that nurses considered their participation in the stance of maintaining or sustaining treatment as inadequate. The nurses felt that the cooperation with the physician in the decision-making did not work and felt a frustration related to not being listened to. Additional barriers to nurse’s participation in the decision-making appeared by nurse’s lack of knowledge regarding laws, guidelines and nursing ethics, as well as lack of work experience and confidence. Conclusion The nurse’s participation in the caring team about the stance of maintaining or sustaining life support care is inadequate. The study also highlight the nurses need for increased knowledge of laws, guidelines and ethics. / <p>Röda Korsets sjuksköterskeförening stipendium 2017</p>

O processo de ensino-aprendizagem na contemporaneidade deve ser motivo de inquietude pelo avanço da tecnologia e pelo perfil dos nativos digitais. O uso de Tecnologias Educacionais Digitais (TED) deve ser inserido no ensino de Ressuscitação Cardiopulmonar (RCP). A American Heart Association (AHA) incentiva o ensino da RCP em diferentes modalidades. Objetivo: Desenvolver TED - videoaula, vídeo de simulação, e instrumentos de avaliação - teórico e prático, sobre RCP no adulto em Suporte Básico de Vida (SBV), com o uso do Desfibrilador Externo Automático (DEA), no ambiente hospitalar. Metodologia: Trata-se de uma pesquisa aplicada e de produção tecnológica desenvolvida na Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (EERP/USP). A população foi composta por 16 experts em Urgência e Emergência (UE). Para a avaliação e validação, por meio de instrumentos adaptados, do roteiro/script e storyboard de uma videoaula, roteiro/script e storyboard de um vídeo de simulação, questionário e Exame Clínico Objetivo e Estruturado (OSCE), sobre RCP no adulto em SBV com o uso do DEA em ambiente hospitalar. Para seleção dos expertises foi adotado pontuação mínima de cinco pontos nos critérios de Fehring (1987). Na trajetória metodológica para elaboração dos vídeos foi adotado o modelo proposto por Fleming, Reynolds e Wallace (2009) que consiste em Fase I: Pré-produção, Fase II: Produção e Fase III: Pós-produção. Para elaboração do questionário foi aplicado as regras básicas para elaboração de Questão de Múltipla Escolha (QME) do manual do Conselho Nacional de Examinadores Médicos. O OSCE foi elaborado de acordo com as orientações do Medical Concil of Canadá. As diretrizes da AHA publicadas em 2015 foram a primeira literatura adotada. A pesquisa foi aprovada no Comitê de Ética em Pesquisa (CEP), conforme Resolução 466/2012. Para a apreciação dos dados foi aplicado estatística descritiva e análise de concordância inter-avaliadores por AC1 de Gwet. Categorização da concordância de acordo com Landis e Koch (1997). Os vídeos foram validados em relação ao objetivo, conteúdo, relevância, ambiente, linguagem verbal e inclusão de tópicos. O questionário e OSCE foram validados em relação à organização, objetividade e clareza. Resultados: Os experts são compostos por enfermeiros (100%), predominância do sexo feminino, idade média de 36,56 anos, média de tempo de formação de 12,93 anos, 93,75% com titulação em mestrado, 93,75% com prática clínica em UE no adulto, distribuídos nas regiões Sudeste, Centro-Oeste e Nordeste do Brasil, 62,5% classificados nos critérios de Fehring (1987), com dez ou mais pontos. Todos os itens dos instrumentos de validação registraram predomínio em respostas positivas. Em relação à concordância inter-avaliadores a videoaula foi classificada em \"concordância moderada\", vídeo de simulação em \"concordância considerável\", questionário e OSCE em \"concordância quase perfeita\". A videoaula foi finalizada em 17 minutos e 17 segundos, o vídeo de simulação com 13 minutos e 22 segundos, o questionário com 20 QME e OSCE com 40 itens. Conclusão: O uso de vídeos e a adoção de instrumentos de avaliação adequados no processo de ensinoaprendizagem é um desafio. Por meio da utilização dos objetos validados neste estudo é possível conduzir estratégias de ensino, pesquisa e extensão em contexto contemporâneo e atualizado / The teaching-learning process in the contemporary world must be cause for concern for the advancement of technology and the profile of digital natives. The use of Digital Educational Technologies (DET) should be inserted in the teaching of Cardiopulmonary Resuscitation (CPR). The American Heart Association (AHA) encourages the teaching of CPR in different modalities. Objective: To develop DET - videotape, simulation video, and evaluation instruments - theoretical and practical, on adult CPR in Basic Life Support (BLS), using the Automatic External Defibrillator (AED) in the hospital setting. Methodology: This is an applied research and technological production developed at the Ribeirão Preto Nursing School of the University of São Paulo (EERP / USP). The population was composed of 16 experts in Urgency and Emergency (UE). For the evaluation and validation, through adapted instruments, of the script/screenplay and storyboard of a videotape, script/screenplay and storyboard of a simulation video, questionnaire and Objective and Structured Clinical Examination (OSCE) on adult CPR in BLS with the use of AED in a hospital environment. For selection of the expertises, a minimum score of five points was adopted according to Fehring (1987) criteria. The model proposed by Fleming, Reynolds and Wallace (2009), which consists of Phase I: Pre-production, Phase II: Production and Phase III: Post-production, was adopted. For the preparation of the questionnaire the basic rules for the elaboration of the Multiple Choice Question (MCQ) of the manual of the National Council of Medical Examiners were applied. The OSCE has been developed in accordance with the guidelines of the Medical Council of Canada. The AHA guidelines published in 2015 were the first adopted literature. The research was approved by the Research Ethics Committee (REC), according to Resolution 466/2012. For the evaluation of the data, descriptive statistics and interrater concordance analysis by Gwet\'s AC1 were applied. Categorization of agreement according to Landis and Koch (1997). The videos were validated in relation to the objective, content, relevance, environment, verbal language and inclusion of topics. The questionnaire and OSCE were validated in relation to organization, objectivity and clarity. Results: The experts are composed by nurses (100%), female predominance, mean age of 36.56 years, average training time of 12.93 years, 93.75% with a master\'s degree, 93.75% with clinical practice in the UE in adults, distributed in the Southeast, Midwest and Northeast regions of Brazil, 62.5% classified as Fehring (1987), with ten or more points. All the items of the validation instruments registered a predominance in positive responses. Regarding inter-rater agreement, the videotape was classified as \"moderate agreement\", simulation video in \"considerable agreement\", questionnaire and OSCE in \"nearperfect agreement\". The videotape was finalized in 17 minutes and 17 seconds, the simulation video with 13 minutes and 22 seconds, the questionnaire with 20 MCQ and OSCE with 40 items. Conclusion: The use of videos and the adoption of appropriate assessment tools in the teaching-learning process is a challenge. Through the use of validated objects in this study it is possible to conduct teaching, research and extension strategies in a contemporary and updated context

<p>Syftet med denna C-uppsats är att synliggöra hinder och möjligheter för att inom ämnet idrott och hälsa implementera hjärt-lungräddning samt belysa och problematisera kring en eventuell framskrivning av hjärt-lungräddningsbegreppet, HLR, i kursplanens uppnåendemål i år nio. Uppsatsen baseras på en kvalitativ intervjustudie genomförd i Stockholm hösten 2006. Våra intervjupersoner har alla anknytning till skolämnet idrott och hälsa och de är aktörer på tre olika nivåer i skolvärlden. Skolverket representerar formuleringsarenan, lärarutbildarna representerar transformeringsarenan och idrottslärarna representerar realiseringsarenan. De har alla fått resonera kring målet om livräddande första hjälp och dess betydelse, legitimitet och uppnåbarhet, vilka intentioner som kan tänkas ligga bakom målformuleringen och vad som kan tala för respektive emot att även inkludera HLR-begreppet. Vi har sett både hinder och möjligheter för HLR i idrottsundervisningen. Faktorer som tid, ekonomi och lärarattityder spelar in. Dessa ger oftast sken av att utgöra hinder för livräddningsundervisningen, men egentligen skulle det inte behöva vara så. Tid finns om man bara vill då dagens öppna kursplan tillåter lärarna att själva disponera den. Okunskap verkar till viss del ligga bakom argumentet om ekonomi – strukturerat och genomtänkt behöver inte momentet bli så kostsamt. I slutänden verkar det som om lärarattityden är det avgörande för vad som kommer med i undervisningen – prioriteras inte ett moment så blir det inte någonting som eleverna får kunskaper i, utan endast ”ett hum om”. På frågan huruvida HLR bör skrivas in i målets formulering eller inte finns det inget enkelt svar, men kanske skulle en framskrivning trots allt resultera i bättre förutsättningar för livräddningsundervisningen och en större kunskap hos skolelever i hur de kan hjälpa en människa i nöd.</p><p>Life-saving and BLS in Physical ecucation</p>

Abstract Nurses constitute the largest group in the healthcare workforce and are called on to assist in emergencies such as disasters. Research has shown that professionals with higher levels of knowledge are more likely to respond to actual emergencies. Yet most hospital based nurses do not possess the skills needed for disaster response. The Basic Disaster Life Support (BDLS) course, with its comprehensive content, represents the gold standard for disaster education. Since confidence also plays a role in response, a tool to measure this variable could be useful. There were five purposes of this study: determine whether one teaching method (computer or classroom instructor-led) is superior over another for disaster education; evaluate how knowledge retention varies between instructional models; examine whether a correlation exists between self-efficacy and disaster knowledge; pilot a new instrument, Disaster Self-Efficacy Scale (DSES); complete psychometrics on the Basic Disaster Life Support exam. The study was an experimental pretest/posttest/follow-up with a single between-group factor (type of training with three levels) and three within-group factors measured at three intervals. The sample included 82 hospital-based nurses randomly assigned to a computer-based, instructor-led, or control group. A MANOVA and MANCOVA were conducted to evaluate group differences at three time intervals. Psychometric evaluation was conducted on both the BDLS and the piloted Disaster Self-Efficacy measures. The BDLS test was shown to be in need of revisions and updating. The DSES measure shows promise for determining disaster self-efficacy and may be useful to target training though it needs further validation. Learning results showed that when controlling for pretest differences, experimental groups had higher posttest BDLS and DSES scores than the control group but there was no difference between experimental groups. There was no difference between experimental groups for BDLS scores at follow-up. Conclusions were that training, regardless of how it was delivered, led to a dramatic increase in disaster knowledge and disaster self-efficacy; computer-based education is a feasible alternative to teaching BDLS; retention still poses a challenge for disaster education. Implications for nursing education and practice were identified. Future research should focus on further development and validation of the DSES and BDLS instruments.

Syftet med denna C-uppsats är att synliggöra hinder och möjligheter för att inom ämnet idrott och hälsa implementera hjärt-lungräddning samt belysa och problematisera kring en eventuell framskrivning av hjärt-lungräddningsbegreppet, HLR, i kursplanens uppnåendemål i år nio. Uppsatsen baseras på en kvalitativ intervjustudie genomförd i Stockholm hösten 2006. Våra intervjupersoner har alla anknytning till skolämnet idrott och hälsa och de är aktörer på tre olika nivåer i skolvärlden. Skolverket representerar formuleringsarenan, lärarutbildarna representerar transformeringsarenan och idrottslärarna representerar realiseringsarenan. De har alla fått resonera kring målet om livräddande första hjälp och dess betydelse, legitimitet och uppnåbarhet, vilka intentioner som kan tänkas ligga bakom målformuleringen och vad som kan tala för respektive emot att även inkludera HLR-begreppet. Vi har sett både hinder och möjligheter för HLR i idrottsundervisningen. Faktorer som tid, ekonomi och lärarattityder spelar in. Dessa ger oftast sken av att utgöra hinder för livräddningsundervisningen, men egentligen skulle det inte behöva vara så. Tid finns om man bara vill då dagens öppna kursplan tillåter lärarna att själva disponera den. Okunskap verkar till viss del ligga bakom argumentet om ekonomi – strukturerat och genomtänkt behöver inte momentet bli så kostsamt. I slutänden verkar det som om lärarattityden är det avgörande för vad som kommer med i undervisningen – prioriteras inte ett moment så blir det inte någonting som eleverna får kunskaper i, utan endast ”ett hum om”. På frågan huruvida HLR bör skrivas in i målets formulering eller inte finns det inget enkelt svar, men kanske skulle en framskrivning trots allt resultera i bättre förutsättningar för livräddningsundervisningen och en större kunskap hos skolelever i hur de kan hjälpa en människa i nöd. Life-saving and BLS in Physical ecucation

No description available.

Thesis (M.S.) -- Mississippi State University. Department of Electrical and Computer Engineering. / Title from title screen. Includes bibliographical references.